Specialty Reimbursement Case Manager

Randstad USA; United States; Remote; USD 23,000 - 32,000; Full time

Benefits offered by this job

Equipment provided

Job summary

Randstad USA is seeking an experienced Case Manager for a fully remote specialty pharmacy support role. This advanced position requires autonomy, deep industry knowledge, and the ability to manage the entire lifecycle of patient cases from initial contact to final resolution.

You will resolve complex insurance and access problems, handle prior authorizations and appeals, research funding options, and mediate difficult payer issues to ensure patient outcomes.

Qualifications

• High School Diploma or equivalent required; additional education preferred.
• Must have direct experience in Benefit Investigations, Medicare/Medicaid, or insurance company work within the last 3 years.
• Proficient with MS Office and video conferencing tools; strong typing (40 WPM).
• Must be able to work independently within established procedures and meet daily/weekly metrics.

Responsibilities

• Case Management: monitor accounts from initial contact through final approval or denial.
• Insurance & Benefit Verification: contact insurance companies to verify coverage and benefits.
• Payer Mediation: resolve complex payer and specialty pharmacy issues.
• Alternative Funding Research: explore funding options and foundations for patient eligibility.
• Patient & Pharmacy Coordination: verify coverage, confirm approvals/denials, coordinate with dispensing pharmacies.
• Patient Support: resolve complex patient inquiries about assistance status.
• Documentation & Compliance: transcribe case details into software and document Adverse Events.

Skills

Typing 40 WPM

Microsoft Office

Video conferencing

Education

High School Diploma or equivalent

Tools

Microsoft Office

Microsoft Teams

Zoom

Job description

We are seeking an experienced, high-level Case Manager to join our fast-paced remote specialty pharmacy support team. Please note: This is not an entry-level care coordinator role handling routine referrals. It is an advanced specialty position requiring high autonomy, deep industry expertise, and independent problem-solving skills to manage the full investigative and backend lifecycle of patient cases.

In this role, you will apply advanced skills to resolve complex insurance and pharmacy access problems, handle prior authorizations and appeals, research foundation funding, and mediate effective resolutions for difficult payer issues.

• Hourly Compensation: $20.00 / hour
• Location: 100% Work from Home (Remote – All U.S. residents eligible)
• Operational Schedule: Must be available for any assigned 8-hour shift between 7:00 AM - 7:00 PM CST
• Training Schedule: 8:00 AM - 5:00 PM CST (First 4 to 6 weeks; mandatory virtual attendance)
• Attendance Requirement: Mandatory NO TIME OFF during the first 5-6 weeks of the position

Key Responsibilities

• Case Management: Dynamically monitor system accounts for new incoming patient cases and steward accounts from initial contact through final approval or denial.
• Insurance & Benefit Verification: Conduct direct outbound contact with insurance companies to obtain, verify, and document accurate benefit information related to patient coverage.
• Complex Payer Mediation: Mediate effective resolutions for complex payer and specialty pharmacy issues toward positive outcomes for patients.
• Alternative Funding Research: Conduct exhaustive research on alternative funding options and foundations to determine patient eligibility for specialty products.
• Patient & Pharmacy Coordination: Perform outbound calls to patients to confirm coverage approvals/denials and co-pays, and coordinate verification with dispensing specialty pharmacies.
• Patient Support: Independently resolve complex patient inquiries regarding the absolute status of their assistance requests.
• Documentation & Compliance: Accurately transcribe detailed case information into proprietary software while conversing via phone. Identify, document, and compliantly submit Adverse Events (AE) during customer contacts or via received documentation.

Requirements & Qualifications

• Education: Minimum of a High School Diploma or equivalent required; additional education preferred.
• Mandatory Core Experience (Must be within the last 3 years): Direct experience in Benefit Investigations, navigating Medicare/Medicaid, HUB re-enrollment assignments, pharmacy operations, or working directly for an insurance company.
• Technical Skills:
• Typing speed of at least 40 WPM with the ability to accurately transcribe notes while speaking.
• Strong proficiency with Microsoft Office Products and video conferencing tools (Microsoft Teams, Zoom). Comfort working on video as required by leadership.
• Core Capabilities: Proven ability to work independently within established procedures, apply advanced skills to complex problems, prioritize concurrent assignments, and achieve daily/weekly metrics.

Remote Workspace & Equipment Requirements

Company-issued computer equipment and technology will be provided. You must provide a dedicated, quiet, private, and distraction-free workspace along with a hardwired network connection meeting the following strict specifications:

• Connection Type: Secure, high-speed broadband internet (DSL, Cable, or Fiber) physically hardwired to the router with a surge protector. (Wi-Fi, dial-up, satellite, and cellular connections are strictly prohibited).